Alcoholism or Alcohol Use Disorder? Does It Matter?

Alcoholism or Alcohol Use Disorder? Does It Matter?

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This post was originally published on July 9, 2015.

A hot contention in the addiction conversation today is whether or not alcoholism is a “disease.” More specifically, whether or not the word alcoholic should be banished from our language.

The term has already been banished from the medical community, at least the psychiatric community. If you open up the psych bible—the Diagnostic and Statistical Manual of Mental Disorders—you won’t find an entry for alcoholic or alcoholism. The fifth edition, which hit the shelves in 2013, only has an entry for “Alcohol Use Disorder.”

The precise definition of the term is, “a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol.”

“Alcohol Use Disorder” suggests problem drinking is a spectrum, like autism or what is now known as bipolar spectrum disorder. There are the low-bottom cases—people drinking around the clock who are physically dependent on alcohol and must chug booze first thing in the morning to ward off the jitters. There are the binge drinkers, who go months without drinking only to go on crazy benders. Then there are those who are stupid enough to get in the car and drive after downing two glasses of wine. There are the kids who party too hard in adolescence and young adulthood and snap out of it by the time they’re 25. There are those who drink everyone under the table during personal hardships like death of a loved one, but then they snap back to drinking normally once their grieving subsides.

You get all kinds.

I have personally encountered people who fit in all these categories, people some might dub alcoholics, when in fact, these folks have gotten it together and started drinking sanely again. I was never physically dependent on alcohol, but I was also too dumb to realize if I chugged booze the morning after a crazy night it would cure the hangover. Typically, the morning after binge drinking I felt so ill, the thought of drinking made me sicker—the last thing I wanted to do was drink. I’d swear off the stuff for good, “I never want to feel this way again!” After two weeks of not touching a drop, I’d go back at it, sometimes just having a few glasses and sometimes getting disgustingly drunk again.

My drinking did progress though. The intervals between binges got shorter, the consequences got more and more severe, the quantity of booze I drank spiked. I do believe that maybe a few years down the line, if I kept drinking, I could have developed a physical dependency.

Thankfully, drinking ripped my life up so tragically I had to stop the nonsense and give the alcohol up for good.

But am I an alcoholic? Or just a problem drinker?

Does the word alcoholic belong in our speech? If it doesn’t, how does that affect my involvement in AA and that first step that says, “We admitted we were alcoholics, that our lives had become unmanageable”?

Personally, I just don’t care one way or another about the semantics. Many people who saw me get sober went on and on about how I wasn’t an alcoholic, including family members, although they emphasized that I should never drink again. If this is the case, who cares if I need to label myself as an alcoholic if doing so will help me recover from that “seemingly hopeless state of mind and body?”

Apparently, lots of problem drinkers take issue with the word. They don’t want to be labeled as such, they don’t want to think they’re like those gutter drunks in the old days. Usually those who were never physically dependent on liquor especially take issue with the label.

Add to this the fact some medical professionals believe alcoholism, and even drug addiction, is not disease, and you’ve got a bunch of questions.

Lance Dodes, for example, notable AA critic, does not believe alcoholism is a disease. The term was adopted by the American Medical Association in 1956, and people like Dodes indict AA for making that happen. But if you look at medical history, conditions, diagnoses and treatments change constantly over time.

Calling anyone mentally retarded is a total slight—the proper term is intellectually disabled.

Calling someone handicapped is also a faux pas—it’s physically disabled or physically challenged.

Don’t call a person who stand under three feet a midget—call them a little person.

The term manic-depressive was axed out of the psychiatric community two decades ago—the correct term is bipolar.

Schizophrenics are not crazy or psychotic—they suffer from a thought disorder.

And now, calling someone an alcoholic is clinically incorrect—the proper term is someone with alcohol use disorder.

So if anyone, be they in AA, sober or not sober, an addiction specialist, a drug and alcohol counselor, a social worker, a medical doctor or a psychiatrist, gets upset at the shift in terminology, I say they need to get with the times.

As far as the disease model is concerned, to me, it doesn’t really matter. Some people who may have been told they suffer from a hopeless disease might be able to drink safely, as those who don’t believe in the disease model suggest. Others, like me, can absolutely not drink safely—I’ve proven this over and over and over.

I’ve tried to stop and can’t. I’ve tried to moderate, and, seven drinks later, there goes the car! I’ve tried to stick to beer, and, ten beers later, I’m driving plastered to yet another bar alone to cry by myself and guzzle vodka.

Whether I have a disease or not really doesn’t matter to me. To drink would be absolutely foolish, and today I have no reason to drink. I’ve pondered this. Why, at 36, would I need to drink. To fit in? To get laid? For the taste? I’d rather eat cake or drink a blood orange Pelligrino. I have more important things to do with my time then go to a bar and hang around a bunch of trashed people until two in the morning.

So, to my mind, whether alcoholism is a condition, whether it’s a disease, whether it’s a spectrum, doesn’t matter at all. What matters is I know I can’t drink safely. I refuse to take a chance, play the fool, and wind up with dire consequences. This does not mean that I assume everyone out there is like me, that everyone who comes into AA is a “real” alcoholic, that everyone on a court order with a DUI has a hopeless disease of alcoholism.

I can’t say that. Evidence proves this isn’t the case, just as evidence proves when I drink shit falls apart.

I personally have no interest in drinking like a lady, and therefore have no interest in drinking at all. Plus, I’d rather save the calories for cake, thank you very much.

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3 Comments

  1. Mike Pinkerton on

    Editor—I somehow submitted my reply before I finished it…can it be returned to me for completion?

    Thanks,

    Mike

  2. An addiction researcher, Carleton Erickson, doesn’t like the term “alcoholic” because it’s not precise. The psychiatrists in charge of the DSM (Diagnostic and Statistical Manual) changed the diagnostic label from (alcohol or other substances) “abuse” and “dependence” to “substance use disorder” with the DSM-5.

    The older distinction was helpful because it recognized two separate types of substance use disorders, if it was used right. “Dependence” usually applied to individuals who were physically “addicted” to a substance; “abuse” to people who weren’t. There was always a grey middle, where people could fit into either abuse or dependence. So in their infinite wisdom, psychiatrists decided to do away with the distinction. They actually did the same with other “disorders,” putting them all on a continuum.

    I like to see “alcoholic” and “addict” as a self-imposed label a person puts on themselves—and not see them as diagnostic terms. So saying you are an alcoholic at an A.A. meeting means you believe you belong there with others who have the desire to stop drinking and recognize that you are powerless over alcohol.

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Tracy Chabala is a freelance writer for many publications including the LA Times, LA Weekly, Smashd, VICE and Salon. She writes mostly about food, technology and culture, in addition to addiction and mental health. She holds a Master's in Professional Writing from USC and is finishing up her novel.